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Lung cancer is common. In the UK, over 49,000 people were diagnosed with lung cancer in 2019, for instance.

An estimated 72% of lung cancer cases in the UK are caused by smoking. In addition, recent evidence suggests a link between cooking-oil fumes and the development of lung cancer.

A systematic review found that higher lifetime exposure to cooking-oil fumes was associated with an increased risk of lung cancer in never-smoking women in high-income countries.

• Indoor air contains distinct pollutants that derive directly from household activities such as cooking, heating, cleaning and sweeping, as well as volatile organic compounds from household furnishing.
• Pollutants that are generated by cooking oils have been shown to be mutagenic, containing polycyclic aromatic hydrocarbons, aldehydes, carbonyl compounds and other mutagens.

Three papers were included in the systematic review, with a total of 3734 participants.

• All studies were “conducted in Taiwan or Hong Kong, focusing on Chinese women using traditional Chinese cooking methods.”
• All three studies found a dose–response correlation between exposure to cooking fumes and the risk of developing lung cancer in never-smokers.

The study also delineated the risk associated with cooking-oil fumes by factors such as “cooking time-years” – measuring exposure to cooking fumes over a participant’s lifetime – to further identify specific cooking behaviours associated with lung cancer development.

The study authors stated: “Exposure to cooking fumes is linked to lung cancer due to the levels of carcinogens that can be produced during the heating of oils to high temperatures.”

For more details concerning the risk of cooking-oil fumes and the development of lung cancer, see GPnotebook.

Other highlights in this month’s email include an update with respect to the use of direct oral anticoagulants in people with cancer and the significance of oestradiol levels while taking hormone replacement therapy.

• May–Thurner syndrome: This is a condition in which patients develop iliofemoral deep venous thrombosis due to an anatomical variant in which the right common iliac artery overlies and compresses the left common iliac vein against the lumbar spine. May–Thurner syndrome is an underdiagnosed cause of iliofemoral deep vein thrombosis, accounting for 2–5% of all deep vein thromboses. The condition is summarised on GPnotebook.
• Hormone replacement therapy and oestradiol levels: Is there value in checking serum oestradiol if a patient is taking oral oestradiol? Is it possible to distinguish between endogenous and exogenous oestradiol through serum oestradiol testing? Recent guidance regarding oestradiol levels and hormone replacement therapy is summarised on GPnotebook.
• Direct oral anticoagulants in people with cancer: This section of GPnotebook has been updated.
• Lung cancer risk associated with cooking-oil fumes: Are ventilation hoods protective against the risk of lung cancer development when cooking with oil? Is the number of dishes cooked daily a greater indicator of lung cancer risk than the number of cooking years?
• Sister Joseph nodule: This was mentioned on a recent discharge letter that I saw. A sister Joseph nodule is a metastatic tumour deposit in the umbilicus, the anatomical region where the peritoneum is closest to the skin. Which primary cancers are most often associated with the development of this lesion?
• Ostium secondum atrial septal defect: This section of GPnotebook has been updated.